As we slowly usher in 2021 and the sounds of “Auld Lang Syne” begin to fade, I would like to highlight several essential agenda items for behavioral health. In the new year, we must bring these items forward, reaffirm their importance, and act on them. These are field-wide issues that involve all of us, and that will affect all of us as we go forward into the future.
COVID-19 adds urgency to this call to action. It has fostered a pandemic within a pandemic—the community prevalence of behavioral health conditions is at pandemic levels. Clearly, we do not have the capacity today to address problems of this scale.
All human systems, including behavioral health, have imperatives that must be met if the system is to remain viable and not dissipate and disappear. There are four such general imperatives for all systems:
Pattern maintenance consists of all the activities that are undertaken to bring new entrants into a system and to keep current members up to date on activities, norms, and cultural frameworks. Over the past two decades, issues have continued to grow around the need to train a larger number of new behavioral health providers each year, including peers, in ways that reflect our growing knowledge and changing patterns of provider-client interactions. Similar comments could be made about the need to improve training for our current providers. Because of lack of sufficient attention and resources, these issues have mushroomed into a crisis, inflamed even more by the COVID-19 pandemic. In 2021, it is imperative that we set up a field-wide group to develop, promote and implement a consensus-based agenda for addressing our human resource crisis. Single disciplinary interests will need to be set aside if progress is to be achieved.
Integration refers to the steps taken to promote communication and synchrony among the different components of a system. After more than a half-century of discussion, behavioral health still has a glaring chasm between those who advocate for inpatient and residential care, and those who advocate for community services. This chasm makes all of us less effective, and it dissipates our energies. We should instead be focused on developing consensus around better outcomes, greater self-direction, and engaging lives for consumers. Leaders on both sides of this issue need to come together, agree to set aside stereotypic beliefs, and work toward a common vision that we all can share. Continuation of this internal dispute at a time when the external problems we face are so great will not serve us well going forward.
Adaptation involves ongoing actions taken to modify a system so that it can respond effectively to changes in its own environment. The environment in which behavioral health operates has shifted dramatically in the past several decades, and even greater change is likely in the future. Integration of care, management of care and virtuality of care are three prime examples of dramatic environmental changes. Our response to these environmental changes has been uneven. The almost instantaneous shift to virtual care in response to COVID-19 has been little short of miraculous. By contrast, our slowness in adoption of integrated care and our difficulty in implementing value-based purchasing reflect a growing disparity with our external environment. We must engage our best minds this year to devise ways that we can improve our adaptation to these fundamental changes. Doing nothing is not an option.
Goal attainment reflects the system’s efforts and degree of success in meeting the purpose for which it was designed. The fundamental question is whether we actually are achieving the goals for which behavioral health was designed. Are we able to engage and return consumers to happy and productive lives in the community? Unfortunately, we do not have a clear answer to this question because we do not currently collect the comparable information necessary to make this determination on a systemwide basis. Thus, an urgent need exists to undertake a national effort, much like the Australians have done, to collect and report national service outcome data. This effort will need to include not only data on clinical improvement, but also personal well-being, the new metric currently being introduced into the health field.
Pattern maintenance, integration, adaptation, and goal attainment are imperatives for behavioral health, not optional activities. We must treat them as such and give them the attention that imperatives warrant.